Blog Posts File in: obesity

The female hormone estrogen is known to offer protection for the heart, but obesity may be taking away that edge in adolescent girls. Research from the University of California at Merced finds that although obesity does not help teens of either gender, it has a greater impact on girls’ blood pressure than it does on boys’. In a study of more than 1,700 adolescents between 13 and 17 years old, obese boys were 3.5 times more likely to develop elevated systolic blood pressure (SBP) than non-obese boys, but similarly obese girls were 9 times more likely to develop elevated systolic blood pressure than their non-obese peers.

Systolic blood pressure, which is represented by the top number in a blood pressure reading, is the amount of force that blood exerts on blood vessel walls when the heart beats. High systolic measurements indicate risk for heart disease and stroke. Rudy M. Ortiz, PhD, Associate Professor of Physiology and Nutrition and his team obtained their data by direct measurements during the school district’s health surveys and physicals to assess the teenagers’ systolic blood pressure (SBP) against two health indicators: body mass index (BMI), which was categorized as normal weight, overweight, or obese, and blood pressure, which was categorized as normal, pre-elevated, or elevated. The researchers found that the teenagers’ mean BMI was significantly correlated with mean SPB for both sexes when both BMI and blood pressure assessments were used. They also found a significant correlation between BMI and SBP as a function of blood pressure, suggesting that the effect of body mass on SBP is much greater when it is assessed using blood pressure categories. “We were able to categorize the students in different ways, first based on BMI within each of three blood pressure categories. Then we flipped that around and looked at each category of blood pressure for different weight categories. In each case, we are looking at SBP as the dependent variable,” said Dr. Ortiz. An odds ratio analysis revealed that obese boys were 2 and 3.5 times more likely to develop pre-elevated and elevated SBP, respectively, than boys who were normal weight. Obese girls were 4 and 9 times more likely to develop pre-elevated and elevated SBP, respectively, than girls who were normal weight.

According to Dr. Ortiz, the results do not bode well for obese teens later in life, especially for the girls. “Overall, there is a higher likelihood that those who present with both higher BMI and blood pressure will succumb to cardiovascular complications as adults. But the findings suggest that obese females may have a higher risk of developing these problems [than males].” As for why obesity has a greater impact on SBP in girls than in boys, Dr. Ortiz has a hunch. “This may be where physical activity comes into play. We know, for example, that obese adolescent females participate in 50 to 60% less physical activity than boys in the population surveyed.”

It's important to take steps to prevent obesity at its first onset--for both adolescent boys and girls. Being active and eating healthy foods are great initial steps towards healthy living!

We all know that eating sweet and starchy foods is not the best for our health: but did you know that these foods have been found to increase a woman’s risk of endometrial cancer? Endometrial cancer begins in the uterus and, if it progresses, can lead to a hysterectomy, or even death. Dr. Bandera, of Rutgers University, found that foods containing refined sugar or white flour (found in sweet and starchy foods) can increase one’s glycemic load, which can greatly increase one’s risk for endometrial cancer. The American Institute for Cancer Research (AICR) estimated that 59% of endometrial cancer cases could be prevented in the United States if women exercise for at least 30 minutes daily and maintained a healthy body weight. Estrogen is a known cause for endometrial cancer, and as fat cells secrete estrogen, obesity has been shown as a major cause of this cancer.

Bandera states, “women who are obese have two to three times the rate of endometrial cancer” than those who exercise and maintain a healthy body weight. Bandera also revealed an unexpected piece of research that points to how a certain beverage can protect a woman against endometrial cancer. Interestingly, eight studies have found that coffee can actually lower this risk. Coffee helps regulates insulin and is loaded with antioxidants—both of which can reduce one’s risk of this type of cancer. While Bandera stresses other not-so-positive side effects of coffee (“everything in moderation!”), the decrease in endometrial cancer risk is pretty exciting.

A recent study published by researchers at Duke University highlighted the fact that some populations of women are more receptive to weight-management interventions than programs advertising weight loss. Weight loss is difficult across all populations and many programs aimed at reducing the pounds may end up providing only a temporary reprieve. As weight gain and obesity are ever-increasing concerns, some researchers have tried to tackle this problem from another angle. Instead of designing weight loss programs, health enthusiasts should focus on weight management initiatives for certain populations.

Duke University researcher Gary Bennett, PhD, who headed this study, found that African-American women responded more favorably to a weight control program than the traditional weight loss regime. On average, premenopausal African-American women have more weight gain per year than women of other racial and ethnic groups. Furthermore, by the time African-American women are 59, twice as many “have class 2 obesity as do white women and three times have the prevalence of class 3 obesity.” Current obesity treatments are not as effective for this population of women, and their underrepresentation in clinical trials studying weight loss interventions points to a dire need for understanding and implementing positive approaches to fight obesity. Re-angling the strategy towards prevention of weight gain requires a less-intensive intervention strategy, which many women are more responsive to.

The clinical trial involved overweight and class 1 obese women between the ages of 25 to 44. The women were randomly placed in either a health clinic’s usual care cohort or the experimental “Shape Program.” The intervention program had five primary components: tailored behavior modification goals, weekly self-monitoring by interactive voice response, 12 monthly counseling calls by a registered dietitian, tailored skills training, and a 12-month YMCA membership. After the 18 month trial, patients in the “Shape Program” had a “mean weight loss of more than 2 pounds versus continued weight gain” in the control group. These positive results have inspired Duke researchers to continue unlocking the motivations behind weight management and weight loss in women. Furthermore, this research provides an opportunity for clinicians to breach the subject of weight management with their patients through a new lens.

Women who are obese at the start of their pregnancy may be passing on insufficient levels of vitamin D to their babies, according to a new Northwestern Medicine® study. The study found that babies born to lean mothers had a third higher amount of vitamin D compared to babies born to obese moms.

Vitamin D is fat-soluble, and previous studies have found that people who are obese tend to have lower levels of the vitamin in their blood. In this study, both obese and lean mothers had very similar levels of vitamin D at the end of their pregnancies, yet obese women transferred less vitamin D to their offspring compared to lean women.

“Nearly all of mothers in this study reported taking prenatal vitamins, which may be the reason why their own vitamin D levels were sufficient, but the babies born to the obese mothers had reduced levels of vitamin D,” said Jami L. Josefson, MD, first author of the study. “It’s possible that vitamin D may get sequestered in excess fat and not transferred sufficiently from an obese pregnant woman to her baby.” Josefson is an assistant professor of pediatrics at Northwestern University Feinberg School of Medicine and an attending physician at Ann & Robert H. Lurie Children's Hospital of Chicago.

It is unknown what health risks babies born with vitamin D insufficiency may face. Recent studies have linked low vitamin D in adults to an increase in autoimmune diseases, inflammation, and obesity.

The study, published Jan. 4 in the Journal of Clinical Endocrinology and Metabolism, was designed as part of a longer-term project to investigate whether body fat at birth is a predictor of body fat in later childhood and adulthood. Because vitamin D deficiency is associated with a host of health conditions, including obesity, the researchers included the analysis of the mothers’ and babies’ vitamin D levels.

Vitamin D levels were measured from blood collected from 61 mothers at 36 to 38 weeks gestation and umbilical cord blood was collected from their babies immediately following birth. Body fat, weight, and volume of the babies were also measured/“The range of body fat of the babies in this study was similar to other studies reporting neonatal body fat,” Josefson said. “What was novel about this study was that we found babies born with higher vitamin D levels had more body fat. That's in contrast to studies in children and adults who have an inverse relationship between levels of vitamin D and body fat, where the higher their vitamin D, the lower their fat.”

Josefson said more research needs to be done on the role vitamin D may play in the health of babies, and she plans to continue studying this sample again to follow up on the babies’ health outcomes.“Obese women may need larger amounts of vitamin D supplementation to provide their babies with sufficient levels of vitamin D while they are in the womb,” Josefson said.This study underscores the importance of understanding the evolving relationships between maternal obesity, vitamin D nutritional status and body fat in the neonatal period, childhood, and adulthood, Josefson said.

Women who are obese before they become pregnant may be putting their child at a disadvantage. New research shows that reading and math scores for kids ages 5 to 7 were lower if the mother was obese before she got pregnant. Obesity can alter how a baby receives nutrients and grows inside the womb.

“Fetal period is known as a critical period of brain development, where any disruption in the development during this sensitive period may cause sustained or permanent changes in structures or functions," says Rika Tanda at Ohio State University.

Future moms can give their children the best chance at success by maintaining a healthy weight.

The study in the Maternal and Child Health Journal was supported by the National Institutes of Health.

The FDA recently approved the first weight-loss drug, Belviq (lorcaserin hydrochloride), in 13 years. Arena Pharmaceuticals of San Diego developed the pill to help people lose 3-4% of their body weight when coupled with exercise and a healthy diet. The FDA approved the pill for obese people (BMI over 30) and some overweight people (BMI over 27) who suffer from high blood pressure, high cholesterol, and type 2 diabetes.

Potential weight-loss drugs face increased scrutiny tod
ay by the FDA for efficacy and safety as many recent ones (fenfluramine, for example) have been recalled due to heart-valve complications. In March, the FDA’s advisory committee introduced mandatory tests for cardiovascular risks for all obesity drugs, which makes the current clinical trials even longer.

In 2010, Arena applied for approval of the drug. The FDA denied approval because it was deemed responsible for causing tumors in rats and because it could not definitively rule out an increase in heart-valve defects. The pharmaceutical company conducted echocardiograms for 8,000 patients to determine heart-valve function. This trial could not verify an increase in heart-valve defects in the users of the drug, convincing the FDA to approve it. The company committed to perform six post-marketing studies with a long-term cardiovascular trial that will search for heart attack and stroke risks.

The drug works to suppress food cravings by mimicking the effects of serotonin in the brain. Along with many other vital functions, the neurotransmitter serotonin plays a role in controlling appetite. Within the brain, neurons pass messages back and forth using chemical messengers (neurotransmitters). The messages may involve information concerning emotions, body temperature, behavior and appetite. The specific kind of information delivered varies with which neurons become activated and where the brain becomes stimulated. The neurotransmitter leaves the neuron and enters the synapse (the space between the two “communicating” neurons). The neurotransmitter links with the receptor on the other neuron, which sends the message. This can then be repeated through a process called reuptake. Serotonin qualifies as a neurotransmitter. The drug Belviq mimics serotonin by activating the 2C receptor, which increases the amount of serotonin to carry messages and increases the probability that the message is received. Thus, the drug causes people to eat less and feel full.

Non-diabetic patients reported headache, dizziness, fatigue, nausea, dry mouth and constipation as side effects. Other side effects include serotonin syndrome especially in combination with depression or headache medication that increase serotonin levels or that activate serotonin receptors. The drug may also affect attention or memory. In diabetics, side effects include low blood sugar, pain, cough and fatigue.

On average, a 198-pound patient taking Belviq will lose six to seven pounds in a year. 20% of patients lose at least 10% of their body weight. Comparatively, 47% of patients without type 2 diabetes taking the drug and 23% of those taking a placebo each lost at least 5% of their total body weight. 38% of patients with type 2 diabetes taking the drug and 16% of those taking a placebo each lost at least 5% of their total body weight. Type 2 diabetics who toke Belviq proved to be twice as likely to regulate their blood sugars compared to those who toke the placebo.

While it may help those suffering from diabetes, it may cause heart complications. The company advises patients with congestive heart failure or pregnant patients to not take the drug. CNN’s Dr. Melina Jampolis, a physician nutrition specialist and diet and fitness expert, calls the results modest and says, “But most experts agree that even a 5% weight loss has significant implications in terms of reducing the risk of obesity associated diseases including heart disease and diabetes.”

The drug may be risky, but risks also come with the rising obesity rate such as diabetes and heart disease. With more than 1/3 of the adult population being obese, the drug may prove worthwhile.

In May 2012, an HBO Documentary Films series on obesity, “The Weight of the Nation,” premieres. Make sure you view the trailer, it's explosive! The four-part series—Consequences, Choices, Children in Crisis, and Challenges—highlights several NIH research advances and addresses the factors contributing to the country’s obesity problem. The films are the centerpiece to a public awareness campaign, which also includes a three-part HBO Family series for kids, 12 short films, a website and social media, and a nationwide community-based outreach effort using free film discussion guides and other tools. To visit the website and see the trailer click HERE.

The network, in consultation with NIH and other major health organizations, developed four documentaries focused on obesity. The project also includes a three-part HBO Family series for kids, 12 short features, a social media campaign, and a nationwide community-based campaign to mobilize action to move the country to a healthier weight.

“If we don't take the obesity epidemic seriously as individuals and as a nation, we will pay a serious price,” said NIH Director Francis S. Collins, M.D., Ph.D., who appears in all of the main documentaries in the series. “It's going to take diverse and rigorous research to understand the causes of obesity and to identify interventions that work in the real world. The results from federally funded research, as seen in these documentaries, can help to prevent and treat obesity and its complications.”

More than one-third of adults in the United States and nearly 17 percent of the nation's children are obese, which increases their chances of developing many health problems, including type 2 diabetes, heart disease, high blood pressure, stroke, fatty liver disease, and some cancers. In 2008, the nation's obesity-related medical costs were an estimated $147 billion.

Last weekend I noticed a billboard on the highway that read: Obesity is a disease, it is not a choice! Nice way to avoid responsibility--put the blame elsewhere. This billboard was promoting a weight loss program (not a bad idea, but a misleading headline!) Remember the days when the main excuse for weight gain was "it's a hormonal problem, I can't do anything about it" or "it's in my genes". Yes , there are some hormonal issues (e.g. hypothyroidism) and genetics that can predispose you to weight gain. However, the rise in obesity and its associated health problems far surpasses the number of people who have a hormonal or genetic problem!

In a recent Chicago Tribune interview given by Dr. Donald Lloyd-Jones at Northwestern University about heart disease ( a major outcome of obesity), he points out that "your lifestyle and behavior choices can trump much of genetics." As far as thyroid conditions, the number of people with thyroid problems averages about 16% of the population. And some thyroid conditions actually make you lose weight.

In 2020 in the US, 83 percent of men and 72 percent of women will be overweight or obese. Currently, 72 percent of men and 63 percent of women are overweight or obese (people who are overweight have a BMI of 25 to 29, people who are obese have a BMI of 30 or greater). Obesity is a huge factor when it come to diabetes risk. In 2020, 77 percent of men and 53 percent of women will have dysglycemia (either diabetes or pre-diabetes). Currently, 62 percent of men and 43 percent of women have dysglycemia.

"We’ve been dealing with the obesity trend for the past three decades, but the impact we project on blood sugar is a true shock,” said Donald Lloyd-Jones, MD, chair and associate professor of preventive medicine at Feinberg. “Those are some really scary numbers. When blood sugar goes up like that all of the complications of diabetes come into play."

Less than five percent of Americans currently are considered to have ideal cardiovascular health. The modest six percent improvement in cardiovascular health that is projected for 2020 means better cholesterol and blood pressure numbers for Americans and fewer smokers. Improvements in treatment and control of cholesterol and blood pressure with medication and declines in smoking would partially account for this small boost, but they wouldn’t be enough to offset the weight and diabetes problems Americans face. Projected improvements in diet and physical activity also contribute to the six percent projection, but the absolute increase in Americans who consume ideal diets will remain less than two percent by 2020, if current trends continue.

“Since the 1960s cardiovascular disease death rates have substantially decreased, but if the weight and dysglycemia trends continue to grow past 2020, we are in danger of seeing those overall numbers start to reverse,” Mark Huffman, a cardiologist at Northwestern, said. Achieving a healthy weight through diet and physical activity is the best way most Americans can improve their cardiovascular health, besides quitting smoking.

Just remember, you can have a bowl of cereal in the morning or a chocolate covered donut. It's your choice...not some disease.

The Turkish people love to eat! My husband and I just spent 8 days visiting this interesting country and noticed that very few individuals were obese (or even overweight). There is fast food in the cities but it tends to be buffets with lots of veggies, cheese, lamb and chicken. Some form of yogurt is often a side dish. Instead of soft drinks (which were rare to see), a favorite beverage is made of yogurt, water and salt and is sometimes served in a bowl with a ladle used as a spoon (definitely an acquired taste) and fruit juices which are plentiful. Street vendors offer fresh squeezed pomegranate or orange juice. McDonald's and Burger King's are rare and according to our hosts, quite expensive. They do love their sweets with lots of pastry shops offering nut and fruit based desserts and the famous Turkish delight, a gummy bear-textured candy filled with things like pistachios, coconut and cherries. I cannot figure out why those sweets don't pile on the pounds!

Turkish tea

When you visit someone's home or office, you are offered Turkish coffee or tea often with fruit, nuts, or pastry. And speaking of tea, everywhere we went, we were given small glasses of tea. We met some members of Parliament and tea was offered. We went to a silk scarf shop and we were given tea while we shopped. At the famous Grand Bazaar in Istanbul, there were men walking around with trays filled with glasses of tea, luring you into their shops to look at rugs! It's a traditional way of life for the Turkish people that has only been modernized by the additional choice of herbal options. Because it is primarily a muslim country, many people do not drink alcohol, so that may be a factor in their low obesity rates. Turkey does have a growing wine industry and it will be interesting to follow its progress and impact on the country's cuisine.

Now that I'm back in the USA, I am going to try to eat more like the Turks (which is quite Mediterranean) and see if it makes a difference!

Women who worked a rotating night shift had an increased risk of type 2 diabetes that was not completely explained by an increase in body mass index (BMI), according to results of a prospective study of women who were enrolled in the Nurses' Health Studies. Nurses who had 1 to 10 years of night shift work saw a 5% excess risk for type 2 diabetes compared to women who did minimal to no night shift work. That risk climbed to 40% after a decade of shift work, according to Frank Hu, MD, PhD, from Brigham and Women's Hospital/Harvard School of Medicine in Boston, and colleagues.

Excess risk rocketed to almost 60% for those who had put in 20 years or more, the group reported. Other studies have suggested that rotating night shift work is associated with an increased risk for obesity and metabolic syndrome, both of which are conditions related to type 2 diabetes, they wrote.

Hu's group examined the relationship between the duration of rotating night shift work and the risk of type 2 diabetes in U.S. women who participated in Nurses' Health Studies (NHS) I and II. They also looked at whether greater weight gain was linked to duration of shift work.

Collectively, NHS I and II enrolled nearly 240,000 women. For this study, the women who completed the NHS questionnaire in 1988 or 1989 served as the baseline for this particular study. Participants were excluded if they had diabetes, heart disease, stroke, or cancer at baseline. Follow-up took place at 18 to 20 years.

Rotating night shifts were defined as working at least three nights a month in addition to days and evenings in that same month. The control group consisted of women who did not report a history of rotating night shift work. In both cohorts, women who spent more years in night shift work were older, more likely to have a higher BMI, and be smokers.

In a secondary analysis, they found that night shift work was also associated with an elevated risk for obesity and excessive weight gain during the follow-up period. They suggested that, beyond BMI, a reason for the link between shift work and type 2 diabetes may be "chronic misalignment between the endogenous circadian timing system and the behavior cycles." This misalignment has been pegged as a reason for metabolic and cardiovascular disorders, including increases in glucose and insulin, they wrote.

In an accompanying commentary, Mika Kivimäki, PhD, from University College London, and colleagues said the study "probably represents the most accurate estimate of shift work-type 2 diabetes association available to date, suggesting this effect is comparable in size to that of work stress in coronary heart disease and larger than the effect of work stress on type 2 diabetes."

They suggested that in an increasingly "24/7" society, efforts need to be made to prevent type 2 diabetes among shift workers by promoting healthy lifestyle and weight control. Also, prediabetic and diabetic employees need to be identified early and treated accordingly.
Source reference:Hu FB, et al PLoS Medicine 2011; 8(12).